New Acupuncture Patients

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Thank you for your interest in becoming a patient at Wax and Wane Wellness and incorporating Classical Chinese Medicine in to your life.  Please complete the form below so that I may best accommodate your scheduling preferences. 1-3 business days after your form is received, you will be contacted with the next available appointment times that fit your needs and instructions for how to book. New patients are seen in order, according to the receipt of their inquiry. 

At your initial appointment we will go through your full health history prioritizing your major concerns/goals and addressing any questions you may have before beginning treatment. When we're finished, we'll discuss your overall treatment plan including the visit frequency most beneficial to you. Appointment duration is 90 minutes and cost is $150.

Thank you and I look forward to welcoming you! 

Name *
Name
Phone *
Phone
Please provide a phone number that is best to reach you
We would love to get to know you just a bit before your visit. What is your main motivation for making this appointment? Is there a specific health issue(s) you're hoping to address? Do you have any specific goals you'd like to achieve?
Days of the week you are available *
please check all that apply
Times you are available *
Please check all that apply
Feel free to add any other specifics about scheduling here...
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